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Trauma-Focused Cognitive Behavioral Therapy (TF–CBT) is a treatment intervention designed to help 3- to 18-year-olds and their parents overcome the negative effects of traumatic life events such as child sexual or physical abuse. TF–CBT was created for young people who have developed significant emotional or behavioral difficulties following exposure to a traumatic event (e.g., loss of a loved one, physical abuse, domestic or community violence, motor vehicle accidents, fires, tornadoes, hurricanes, industrial accidents, terrorist attacks). The program targets boys and girls from all socioeconomic backgrounds, in a variety of settings, and from diverse ethnic groups. It has been adapted for Hispanic/Latino children.
TF–CBT was developed by integrating cognitive and behavioral interventions with traditional child abuse therapies to help children talk directly about their traumatic experiences in a supportive environment. The program operates through the use of a parental treatment component and several child–parent sessions. The parent component teaches parents effective parenting skills to provide optimal support for their children. The parent–child session encourages children to discuss the traumatic events directly with the parent, and both parent and child learn to communicate questions, concerns, and feelings more openly.
There have been several randomized controlled trials demonstrating the efficacy of TF–CBT in children ages 3-18. The largest evaluation to date is Cohen and Deblinger’s 2004 study involving 229 sexually abused and multiply traumatized children between ages 8–14. All children in the study were confirmed victims of contact sexual abuse who exhibited multiple symptoms of PTSD. They also all had at least one responsible, nonabusive parent or guardian willing to participate in the parental component of the study. Approximately half of the children and their parents were randomized to 12 weeks of treatment with TF–CBT; the remainder received comparable levels of conventional child-centered therapy. A variety of semistructured interviews, standardized questionnaires, and common psychometric tests (including the K–SADS–PL and the Children’s Depression Inventory) were used to measure participants’ psychiatric symptoms at baseline and after treatment. A multivariate statistical analysis was then performed to determine which group showed greater improvement over the course of the study.
In Cohen and Deblinger’s study, children in the treatment group showed significantly more improvement in their PTSD symptoms (reexperiencing, avoidance, and hyperarousal) than their counterparts in the control group. Their parents also showed greater improvement (than the control parents) in their own self-reported levels of depression, abuse-specific distress, support of the children, and effective parenting practice.
These findings confirm the results of numerous earlier (and smaller) trials, which have repeatedly demonstrated TF–CBT’s efficacy in reducing multiple PTSD symptoms in abused children and their parents. In general, randomized controlled trials have found that, compared with children who received supportive therapy, children who received TF–CBT
In recent studies, TF–CBT has been evaluated for children experiencing PTSD symptoms related to traumatic grief and terrorism. TF–CBT showed promising effectiveness in reducing PTSD symptoms for these children as well.
Cohen, Judith A., and Anthony P. Mannarino. 1996. “A Treatment Outcome Study for Sexually Abused Preschool Children: Initial Findings.” Journal of the American Academy of Child and Adolescent Psychiatry 35(1):42–43.
———. 1997. “A Treatment Study for Sexually Abused Preschool Children: Outcome During a 1-Year Follow-Up.” Journal of the American Academy of Child and Adolescent Psychiatry 36(9):1228–36.
———. 1998. “Interventions for Sexually Abused Children: Initial Treatment Outcome Findings.” Child Maltreatment 3(1):17–27.
Cohen, Judith A., Anthony P. Mannarino, Lucy Berliner, and Esther Deblinger. 2000. “Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents: An Empirical Update.” Journal of Interpersonal Violence 15(11):1202–24.
Cohen, Judith A., Esther Deblinger, Anthony P. Mannarino, and Robert A. Steer. 2004. “A Multisite Randomized Trial for Children With Sexual Abuse–Related PTSD Symptoms.” Journal of the American Academy of Child and Adolescent Psychiatry 43:393–402.
Cohen, Judith A., Anthony P. Mannarino, and Esther Deblinger. 2006. Treating Trauma and Traumatic Grief in Children and Adolescents. Treatment Manual. New York, N.Y.: Guilford Press.
Cohen, Judith A., Anthony P. Mannarino, and Kraig Knudsen. 2004. “Treating Childhood Traumatic Grief: A Pilot Study.” Journal of the American Academy of Child and Adolescent Psychiatry 43:1225–33.
Cohen, Judith A., Anthony P. Mannarino, and Virginia R. Staron. 2006. “A Pilot Study of Modified Cognitive Behavioral Therapy for Childhood Traumatic Grief (CBT–CTG).” Journal of the American Academy of Child and Adolescent Psychiatry 43:1465–73.
Judith A. Cohen, M.D.
Center for Traumatic Stress in Children and Adolescents
Allegheny General Hospital
Four Allegheny Center, Eighth Floor
Pittsburgh, PA 15212
Phone: (412) 330-4321
Fax: (412) 330-4377
E-mail: JCohen1@wpahs.org
Web site: http://www.pittsburghchildtrauma.com
Judith A. Cohen, M.D.
Center for Traumatic Stress in Children and Adolescents
Allegheny General Hospital
Four Allegheny Center, Eighth Floor
Pittsburgh, PA 15212
Phone: (412) 330-4321
Fax: (412) 330-4377
E-mail: tfcbt@musc.edu
Web site: http://www.musc.edu/tfcbt
